Acute severe pain in emergency department: morphine or low-dose ketamine?

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Published Oct 30, 2024
https://doi.org/10.62438/tunismed.v102i11.4574
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Vol. 102 No. 11 (2024): Tunis Med nov 2024

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Khedija Zaouche
Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Mohamed Kilani
Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ramla Baccouche
Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Radhia Boubaker
Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Hamida Maghraoui
Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract

Introduction: Severe pain is a therapeutic emergency that can be life-threatening by its location, its repercussions or the misdiagnosis it can cause.


Aim: To investigate the efficacy of analgesia by morphine versus that by low-dose ketamine in severe pain in emergency department.


Methods: We conducted a randomized open study. We included patients over 18 years-old who consulted for severe pain defined by numeric rating scale (NRS) ≥6. Patients of M group received a titration of 10 mg morphine while those of LDK group, received a bolus of 30 mg of ketamine. The primary endpoint was obtaining a NRS of less than 4 within 10 minutes.


Results: We included 120 patients, 66 in the M group and 54 in the LDK group. The mean baseline NRS was 8.8 ± 1.3 in the M group and 8.6 ± 1.4 in the LDK group (p₌ 0.7). At 10 minutes, the same number of patients in both groups achieved a NRS less than 4 (p = 0.09). However, the mean NRS was significantly lower in the LDK group (p = 0.008). More adverse effects were noted in the LDK group (p <10-3).


Conclusions: Low-dose ketamine appears to be non-inferior to morphine in achieving effective analgesia for severe pain in the emergency department.

Keywords:

Opioids, Ketamine, Analgesia, Pain, Emergencies

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